| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2930 |
Prefabricated stainless steel crown - primary tooth |
9,591 |
2,959 |
$1.74M |
| D1120 |
Prophylaxis - child |
10,347 |
10,264 |
$467K |
| D0120 |
Periodic oral evaluation - established patient |
10,183 |
10,108 |
$448K |
| D1206 |
Topical application of fluoride varnish |
11,503 |
11,417 |
$384K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
3,154 |
1,489 |
$326K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
3,587 |
1,845 |
$288K |
| D7140 |
Extraction, erupted tooth or exposed root |
2,371 |
1,409 |
$254K |
| D0272 |
Bitewings - two radiographic images |
3,948 |
3,926 |
$161K |
| D1351 |
Sealant - per tooth |
3,084 |
975 |
$128K |
| D0140 |
Limited oral evaluation - problem focused |
2,141 |
2,122 |
$119K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
5,291 |
4,955 |
$118K |
| D1110 |
Prophylaxis - adult |
1,129 |
1,126 |
$79K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
728 |
491 |
$76K |
| D2934 |
|
221 |
66 |
$75K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,052 |
1,042 |
$61K |
| D1510 |
|
245 |
199 |
$49K |
| D0230 |
Intraoral - periapical each additional radiographic image |
1,341 |
469 |
$24K |
| D0274 |
Bitewings - four radiographic images |
348 |
345 |
$21K |
| D0220 |
Intraoral - periapical first radiographic image |
867 |
858 |
$20K |
| D0240 |
|
526 |
298 |
$13K |
| D3230 |
|
34 |
13 |
$6K |
| D1330 |
|
119 |
115 |
$5K |
| D2330 |
|
47 |
24 |
$4K |
| D0330 |
Panoramic radiographic image |
26 |
26 |
$3K |
| D2332 |
|
16 |
12 |
$2K |
| D1208 |
Topical application of fluoride, excluding varnish |
12 |
12 |
$330.84 |